At the 2017 RISE Nashville conference Apixio hosted a panel with four of our clients: Doug Loop of OptumCare, Russ Shust of Group Health Cooperative, Jennifer Pereur of Hill Physicians Medical Group, and Alicia Wilbur of Martin’s Point Health Care.
The panel was moderated by Tam Pham,a risk adjustment expert, currently on board with Apixio as Solutions Executive, and formerly of SCAN Health Plan and the University of Pennsylvania Hospital.
A crowd of over 150 showed up to hear these four leaders discuss their thoughts on risk adjustment technology and the challenges facing the industry today. If you missed it, we’ve got you covered— highlights are below:
Strategies to reduce provider abrasion over chart pulls
The panel discussed strategies for securing patient charts while maintaining strong relationships with physicians. Physicians notoriously chafe at pulling charts for risk adjustment, because they just don’t see any benefit on their end from this process.
Two of our panelists laid out how Apixio helped them manage this dynamic in their organizations. Jennifer Pereur described how Hill Physicians moved from manual chart pull to direct EHR extraction for a portion of its providers, enabling them to secure the necessary information while maintaining high physician engagement.
“We started working with Apixio, and the value that this technology has for us first and foremost is provider abrasion. We’re tired of the same process year after year. Our physicians are tired. I was seeing a real drop in compliance in just getting chart retrieval. Every year we were getting a smaller portion of the charts we were targeting.
The way we use this technology is by directly accessing the EHR., We don’t have to bother the office, we just pull the data., We grab all that unstructured data, we run it through the machine, get that valuable information, and there is no burden that’s placed on the office. That’s a real win for us.”
-Jennifer Pereur, Hill Physicians Medical Group
Alicia Wilbur of Martin’s Point Healthcare in Maine had a very different situation. Her physicians didn’t want Martin’s Point to touch their EHR at all, and were comfortable with their existing chart chase vendor who scanned their charts into PDFs. Apixio was able to process and analyze these charts very smoothly, so Alicia didn’t have to make any other asks of her physicians.
“With this technology and being able to read PDFs, it’s really helped us with that portion of our chart review. We’re at a place where we’re about 50/50 with EHR reviews and with the traditional chart chase PDF reviews, and it’s really added some value to that PDF review for us in particular.”
-Alicia Wilbur, Martin’s Point Health Care
The panel also discussed ways to give back to physicians during risk adjustment, so they truly see a benefit from the process, and buy in. Russ Shust floated the idea of giving risk adjustment analyses back to physicians in real-time— telling them when they had missed asking a legacy diabetes patient about their diabetes, for instance. To Russ, creating a joint initiative around quality will help physicians feel like the risk adjustment was a two-way street.
Increasing the speed and scope of chart review
The panelists discussed their hopes to include different types of documentation in the risk adjustment process. Jennifer said that she wants to use authorization requests and care transition documentation. This, she said, is where real efficiencies will be created and how the true picture of patient health can be found— by looking at interactions across the clinical spectrum.
Martin’s Point is already looking at all outpatient records for Medicare Advantage patients, and Alicia said that in 2017, they will also look at all inpatient records. Additionally, they are partnering with an outside quality auditing firm, to receive the documents that they pull as well.
Alicia and Russ made the point that technology like Apixio’s is exactly what enables organizations to increase the scope of their review. Because Apixio speeds the review process, organizations are able to take on more documentation and data instead of worrying if they have the bandwidth to process it. Speaking to this fact, Alicia said: “Technology is helping us create bandwidth within our coding team to be able to look into those records.”
“Time is limited, if you had a finite number of coders to look at your medical records, why not serve them the data they need to look at vs going after a hundred pages of a medical record. The efficiency of a tool like this, it’s impressive.”
-Russ Shust, Group Health Cooperative
The importance of strong quality assurance programs
Every single one of the panelists emphasized the need to QA as many risk adjustment results as possible, to have full confidence in the accuracy of the process.
Russ mentioned that during GroupHealth’s initial project with Apixio, they gave a group of charts which had already been looked through three times (by an auditor, another vendor, and a coder); Apixio was still able to find additional supporti ng HCC evidence. They then audited Apixio’s results to confirm accuracy.
Alicia mentioned that Martin’s Point used a similar process, and gave Apixio charts that had been looked through by their coders several times. They gave Apixio’s findings back to their “quality assurance guru” for validation, and found that they agreed with 94% of Apixio’s results.
Accuracy was of paramount importance to the panelists because of increased CMS scrutiny on risk adjustment in general. Russ mentioned that an especially important part of his risk adjustment process was validating existing codes by cross-chec king that they linked up with a qualifying claim.
Tam pointed out that all RAPS and EDPS files should be given to vendors before the chart review process begins. This will allow for efficiency in the review process to identify conditions that have not been previously captured or to validate conditions which were previously submitted.
The future is bright for risk adjustment
The panel is hopeful about the future of risk adjustment. Doug Loop mentioned that the CMS advance notice didn’t include marked changes to Medicare Advantage, signaling that under the new administration the regulations might remain static, in the near term. And Jennifer mentioned that, if anything, it seemed like risk adjustment might move into new spheres in the coming years, potentially even commercial risk in California.
Jennifer noted that the more widespread risk adjustment became in insurance programs the easier it would be to do high-quality risk adjustment. The burden of engaging physicians would become less once risk adjustment affects more of their patients.
You can watch the entire presentation here.